10.09.59.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Administrative services organization (ASO) means the contactor procured by the State to provide the Department with administrative support services to operate the Maryland Public Behavioral Health System.2) “Definitive drug test” means a drug screening test that includes:. a) The ability to identify individual drugs and distinguish between structural isomers, but not nece

10.09.59.03. 03 General Conditions for Provider Participation.. To participate in the Program, a provider shall:. A. Meet the conditions for provider participation in the Medical Assistance Program as set forth in COMAR 10.09.36.03;B. Meet the conditions for licensure and practice as set forth in COMAR 10.63.01, 10.63.02, and 10.63.06;C. Have clearly defined and written patient care policies; and. D. Maintain, either manually or electronically, adequate documentation of e

10.09.59.04. 04 Provider Requirements for Participation.. A. Individual Practitioner Providers. To participate in the Program as an individual practitioner of specialty mental health services, the provider shall:1) Be licensed and legally authorized to practice independently by the appropriate Board to practice in the state in which the service is rendered; and2) Demonstrate, by training and experience, the competency to provide mental health services as one of the following:

10.09.59.05. 05 Eligibility.. A. A participant is eligible for specialty mental health services if:. 1) The individual meets the Department’s medical necessity criteria; and. 2) The service is appropriate to the specific provider type or community-based mental health provider listed in Regulation .04 of this chapter.B. Individuals are eligible for Psychiatric Rehabilitation Programs for adults if the individual:. 1) Has been referred for psychiatric rehabilitation program services by a l

10.09.59.06. 06 Covered Services.. The ASO shall reimburse the following specialty mental health services rendered to participants when authorized by the ASO:A. Medically necessary specialty mental health services delivered by providers listed in Regulation .04 of this chapter, for which the primary diagnosis is listed in COMAR 10.09.70.02I or J;B. Telehealth services as defined in COMAR 10.09.49; and. C. Presumptive drug tests and definitive drug tests, when ordered by a spec

10.09.59.07. 07 Limitations.. The Program does not cover the following:. A. Services not delivered in compliance with the COMAR references listed in Regulations .04 and .05 of this chapter;B. Services not medically necessary;. C. Investigational or experimental drugs and procedures;. D. Specialty mental health services for participants in an institution for mental disease as defined in 42 CFR §435.1009 unless the service is delivered through the Medicaid Emergency Psychiatric Demonstration;

10.09.59.08. 08 Authorization Requirements.. A. The ASO shall establish a process, through a utilization review system, for authorization of specialty mental health services.B. The ASO shall authorize services that are:. 1) Medically necessary;. 2) Of a type, frequency, and duration that are consistent with expected results and cost-effective; and3) Delivered in a manner consistent with this chapter..

10.09.59.09. 09 Payment Procedures.. A. Payment procedures shall be followed as specified in COMAR 10.09.36.04.. B. A provider shall deliver and document services in accordance with Department regulations in order to receive reimbursement.C. Unless the care is free to other patients, a provider shall bill the Program its usual and customary charge to the general public.D. The Department shall authorize supplemental payment on Medicare claims only if:.